Fig. 10.

An 80-year-old male with history of smoking, hypertension, hyperlipidemia, and critical limb ischemia gangrenous changes to the right second and third toes (a) with underlying metatarsophalangeal joint abscess. AP angiogram of the right infrageniculate circulation (b) demonstrated ostial occlusion of the right anterior tibial artery * (TASC II type D), subtotal occlusion of the peroneal artery (TASC II type C), and 50% proximal posterior tibial artery stenosis (TASC II type A) with no in-line flow to the foot (not shown). Tibial and pedal plantar loop reconstruction was then performed with complete recanalization of the anterior tibial (AT), tibioperoneal trunk (TP), peroneal (P), dorsalis pedis, and lateral plantar (LP) arteries (c, d) . Second and third digits and metatarsophalangeal joint resection with evacuation of abscess was then performed with apparent adequate bleeding post-revascularization (e) . Fluobeam angiography of the resection site was performed demonstrating unexpected areas of hypoperfusion to the wound site and periphery ( white arrows ; f) . Transmetatarsal amputation was performed with adequate macro/microvasculature for stump healing now demonstrated by NIFA (g). Outpatient follow-up showed complete stump healing and ambulation ( h ).